A comparison of reimbursement recommendations by European HTA agencies : Is there opportunity for further alignment?

Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA) to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA) recommendation for centralized marketing authorization. Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations. Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs) approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy) and HTA recommendations. However, there was less alignment between the HTA processes and recommendations. Conclusions: In order to move forward to a more harmonized HTA environment within Europe, it is first necessary to understand the variation in HTA practices within Europe. This study has identified alignment between HTA recommendations and the System taxonomy and one of the major implications of this study is that such alignment could support a more collaborative HTA environment in Europe.Peer reviewedFinal Published versio

Fuzzy DEMATEL analysis of barriers to Blockchain-based life cycle assessment in China

The emerging Blockchain technology can drastically improve the effectiveness and efficiency of life cycle assessment, which is widely used for assessing the environmental impact of products and processes. However, Blockchain adoption is impeded by various barriers including systems-related, external, intra-organizational and inter-organizational barriers. So far, no research has analyzed how these barriers interact with each other for better decision-making in life cycle assessment. This research narrows the knowledge gap by prioritizing the important barriers using a fuzzy Decision-Making Trial and Evaluation of Laboratory (DEMATEL) method. Pairwise comparison data were collected from three representative organizations in China, which all have Blockchain implementation experiences. The results show that the key cause barriers are immaturity of technology, and technical challenges for collecting supply chain data in real time. The prominent barriers include lack of new organizational policies for using technology, and lack of government policy/regulation guidance and support, among others. Managerial implications are discussed based on the results and findings

A Review of the Technical and Socio-Organizational Components of Earthquake Early Warning Systems

Every year, natural hazards affect millions of people around the world, causing significant economic and life losses. The rapid progress of technology and advances in understanding of the highly complex physical phenomena related to various natural hazards have promoted the development of new disaster-mitigation tools, such as earthquake early warning (EEW) systems. However, there is a general lack of integration between the multi- and cross-disciplinary elements of EEW, limiting its effectiveness and applications for end users. This paper reviews the current state-of-the-art in EEW, exploring both the technical components (i.e., seismological and engineering) as well as the socio-organizational components (i.e., social science, policy, and management) of EEW systems. This includes a discussion of specific evidence from case studies of Italy, United States’ West Coast, Japan, and Mexico, where EEW systems have reached varying levels of maturity. Our aim is to highlight necessary improvements for increasing the effectiveness of the technical aspects of EEW in terms of their implications on operational, political/legal, social, behavioral, and organizational drivers. Our analysis suggests open areas for research, associated with: 1) the information that needs to be included in EEW alerts to implement successful mitigation actions at both individual and organizational levels; 2) the need for response training to the community by official bodies, such as civil protection; 3) existing gaps in the attribution of accountability and development of liability policies involving EEW implementation; 4) the potential for EEW to increase seismic resilience of critical infrastructure and lifelines; 5) the need for strong organizational links with first responders and official EEW bodies; and 6) the lack of engineering-related (i.e., risk and resilience) metrics currently used to support decision making related to the triggering of alerts by various end users

Effects of Compensation Systems on Job Search Decisions: An Application of Person-Organization Fit

Past research has demonstrated the importance of pay level in job search and choice processes. Compensation policies other than pay level may have important effects on applicant attraction, yet there has been little research examining this possibility. The role of person-organization fit in job search and job choice decisions has also been supported. Because pay systems define an organization\u27s expectations and culture, they may be an important organizational attribute for individuals to compare with their needs and values; thus the corresponding level of fit between compensation policies and individuals\u27 dispositions may affect subsequent job search and choice decisions. Using several research methods and a sample of individuals currently involved in the interviewing process, this stugy examines both the main and interactive effects of various pay system attributes on job search. Resulting analyses primarily supported the hypotheses, suggesting that many facets of pay systems may have important effects on individuals\u27 job search and choice decisions

Innovation sustainability in challenging health-care contexts : embedding clinically led change in routine practice

The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities

The Democratization of Data in Higher Education: A Case Study of the Challenges that Institutions Face as They Seek to Improve Student Success

In the current climate of increased external accountability and increased internal pressure to improve student performance, many colleges and universities are grappling with how to broaden access to data and information so as to improve decision-making -- a trend this report refers to as the democratization of data. In the past decade, advances in user-friendly information technology are enabling faculty, administrators, and staff to retrieve and analyze a host of information themselves, right from their desktops. For example, they can perform data searches, track student performance, monitor section enrollments in real-time, and estimate various budgetary impacts. By equipping people at all organizational levels with the data and information they need, colleges can enable them to make better decisions about how to reach and serve students. Colleges and universities are finding, however, that the democratization of data brings with it cultural as well as technical or procedural transformations. For example, it requires having departments work together to agree upon the kinds of information to track and to whom to make it available; changing channels of information flow; rewarding efforts to share information and knowledge rather than hoard it; being transparent about budgetary impacts; and valuing a culture of inquiry that identifies areas for improvement and supports analysis that pursues real change over time. Given the robust technological capabilities now available, colleges and universities that seek to understand and improve their rates of student success will inevitably confront, either deliberately or unwittingly, their own institutional practices and attitudes concerning access to and use of data. This report, in describing some of the major challenges that one higher education institution faced as it reconsidered its use of data and information in decision-making, outlines an investigative process to consider when seeking to improve student success and organizational effectiveness through the democratization of data. The report presents findings and identifies several important policy implications, at the campus and state levels, that could improve student outcomes by enhancing the use of data and information in decision-making

Organization Development for Social Change

The field of organization development (OD) has emerged from efforts to improve the performance of organizations, largely in the for-profit sector but more recently in the public and not-for-profit sectors as well. This paper examines how OD concepts and tools can be used to solve problems and foster constructive change at the societal level as well. It examines four areas in which OD can make such contributions: (1) strengthening social change-focused organizations, (2) scaling up the impacts of such agencies, (3) creating new inter-organizational systems, and (4) changing contexts that shape the action of actors strategic to social change. It discusses examples and the kinds of change agent roles and interventions that are important for each. Finally, it discusses some implications for organization development intervention, practitioners, and the field at large.This publication is Hauser Center Working Paper No. 25. The Hauser Center Working Paper Series was launched during the summer of 2000. The Series enables the Hauser Center to share with a broad audience important works-in-progress written by Hauser Center scholars and researchers

An Exploratory Study into Open Source Platform Adoption

Research on open source software has focused mainly on the motivations of open source programmers and the organization of open source projects [17] [19]. Some researchers portray open source as an extension of the earlier open systems movement [36]. While there has been some research on open-systems software adoption by corporate MIS organizations [4] the issue of open source adoption has received little attention. We use a series of interviews with MIS managers to develop a grounded theory of open source platform adoption. We contrast this to prior academic and popular reports about the adoption of open source

Frameworks for Strategic Leadership

I suggest two frameworks that may improve understanding of strategic thinking, strategic decision making, and strategic leadership. The first I call the Epistemology Framework. The second which was described and continues to be promoted by David Snowdon and colleagues is the Cynefin Framework

Healthcare services managers: what information do they need and use?

Objectives: To gain insight into the information behaviour of healthcare services managers as they draw on information while engaged in decision making unrelated to individual patient care. Objectives – The purpose of this research project was to gain insight into the information behaviour of healthcare services managers as they use information while engaged in decision-making unrelated to individual patient care. Methods – This small-scale, exploratory, multiple case study used the critical incident technique in nineteen semi-structured interviews. Responses were analyzed using ‘Framework,’ a matrix-based content analysis system. Results – This paper presents findings related to the internal information that healthcare services managers need and use. Their decisions are influenced by a wide variety of factors. They must often make decisions without all of the information they would prefer to have. Internal information and practical experience set the context for new research-based information, so they are generally considered first. Conclusions – Healthcare services managers support decisions with both facts and value-based information. These results may inform both delivery of health library services delivery and strategic health information management planning. They may also support librarians who extend their skills beyond managing library collections and teaching published information retrieval skills, to managing internal and external information, teaching information literacy, and supporting information sharing